Child-care provider integrity lead must resolve whether to recoup, waive

Situation

Trafficking and Eligibility Fraud work in a Medicaid agency with a surge in MAGI mismatches now turns on to recoup, waive, or refer because a thousand UI claims from one IP block put EBT out-of-state redemption cluster in play. Child-care provider integrity lead should say what EBT out-of-state redemption cluster proves.

Decision

Child-care provider integrity lead in a Medicaid agency with a surge in MAGI mismatches must choose To recoup, waive, / Refer for prosecution using EBT out-of-state redemption cluster after a thousand UI claims from one IP block.

Hypotheses to test

• Authorize To recoup, waive, now; EBT out-of-state redemption cluster already has the discriminator after a thousand UI claims from one IP block.
• Keep Refer for prosecution in force until EBT out-of-state redemption cluster is completed after a thousand UI claims from one IP block for child-care provider integrity lead.
• Treat EBT out-of-state redemption cluster as To recoup, waive, because both readings appear after a thousand UI claims from one IP block.
• Refuse a Public Benefits close: child-care provider integrity lead does not have the page to recoup, waive, or refer turns on in EBT out-of-state redemption cluster.

Analysis required

• Match household facts in EBT out-of-state redemption cluster to the rule that pays the benefit.
• Trace the notice and appeal path child-care provider integrity lead must preserve.
• Test eligibility, recoupment, and improper-payment facts in EBT out-of-state redemption cluster after a thousand UI claims from one IP block.
• For this Public Benefits Trafficking and Eligibility Fraud file, read EBT out-of-state redemption cluster against a thousand UI claims from one IP block and write the one fact that would move to recoup, waive, or refer for child-care provider integrity lead.

Recommendation

Choose To recoup, waive, / Refer for prosecution on this Public Benefits / Trafficking and Eligibility Fraud packet (EBT out-of-state redemption cluster after a thousand UI claims from one IP block). The follow-on Trafficking and Eligibility Fraud action is what child-care provider integrity lead does next: implement the option, assign an owner, and log the missing fact.